A claim is a health care bill that goes to your health plan to be paid. If the health plan says it won’t pay it, it is denying the claim.
Your health plan will send you a letter to tell you why it denied the claim. That letter will also tell you how you can appeal your health plan’s decision. The appeals process is the formal step you take to ask a health plan to pay for something it said wasn’t covered.
The Affordable Care Act requires all new health plans to explain their appeal process. That information may be found in your policy, on the plan's website, or by calling their member services department.